Gastrointestinal pathology Flashcards
(68 cards)
What is cleft lip and palate?
- A Congenital full thickness defect of lip and palate. - The lip or palate is not fused together properly. - Reason: Failure of correctly fusion of facial prominences ( 5 facial prominence: 1) Frontonasal 2) lateral nasal prominence 3) maxillary prominences 4) Medial nasal prominence 5) mandibular prominence
What is aphthous ulcers?
- Ulcers that arise superficially on the oral mucosa and is painful - occurs during stress and resolves spontaneously, but often reoccurs - Is grey with erythematous rim
Behcet Syndrome?
- Characterized by recurrent aphthous ulcers+ulcers in genitals and uveitis (inflammation of Uvea (cilliary body, Iris and choroid) ) - pathogenesis: immune complex mediated vasculitis of small vessels and can be seen after viral infection but generally ethology is unknown -
Oral herpes?
- Usually caused by HSV-1 and leads to formation of vesicles on the oral mucosa and rupture of these vesicles lead to red ulcers that are painful -
Primary infection of HSV-1?
- Primary infection with HSV-1 occurs in childhood - Virus hides in trigeminal ganglion and is dormant - stress and sunlight reactivate the virus leading to formation of vesicles on the lips
Squamous cell carcinoma of oral mucosa?
- It is malignant proliferation of stratified squamous epithelium of oral cavity - major risk factor: tobacco and alcohol - Location: commonly occur in the floor of the mouth. - precursor lesion: Oral leukoplakia and erythroplakia
Difference between erythroplakia, leukoplakia and oral candidiasis?
- oral Leukoplakia: white plaque found in the oral cavity and can not be scrapped away. Represent dysplasia of the squamous epithelium. - Oral candidiasis (thrush): White deposit on the tongue and unlike leukoplakia can be scrapped away. common in immune compromised patient. - Oral Erythroplakia: Vascularised leukoplakia (red plaque), highly suggestive of squamous cell dysplasia. - Erythroplakia and leukoplakia is biopsied to rule out squamous cell carcinoma.
Mumps disease?
- Infection caused by the Mumps virus –> bilateral inflammation of the parotid gland - characterised by orchitis (inflammation of the testicles), pancreatitis and aseptic meningitis - Serum amylase is increased because of involvement of the pancreas and the parotid gland. - orchitis –> sterility.
Sialadenitis?
- inflammation of the salivary gland - commonly caused by the obstructing stone (sialolithiasis) –> staphylococcus aureus infection - symptoms: swelling, redness and pain of the affected area.
What is Pleomorphic adenoma?
- Benign tumor of the salivary glands. Commonly occurs in parotid gland - consists of epithelial tissue (e.g. glands) and stomal tissue (cartilage): biphasic tumor. - Mobile, painless (has not invaded the facial nerve), slow growing and circumscribed mass - recurrence is very common - Rarely transforms into carcinoma and facial nerve damage is the sign for carcinoma
Warthin Tumor?
- Also known as Papillary Cystadenoma Lymphomatosum: Cysadenoma because the ducts are enlarged and filled with serous fluid and cellular debris Papillary because the epithelial cells of the duct form finger-like projection known as papilla. Lymphomatosum because the duct is invaded by the lymphocytes forming germinal-like centres - Benigh tumor and 2nd most common tumor of the salivary glands and almost alway arises in the parotid gland. - Symptoms: The tumor pushes the surrounding structures (facial nerve) leading to the earaches, impaired hearing, tinnitus and facial paralysis. Also swelling is present and is painless.
Mucoepidermoid carcinoma of salivary glands?
- Malignant tumor composed of mucous producing cells (mucinous cells) and squamous cell. - Most commonly arises in the parotid gland and accounts for 35% of malignancies of the major and minor salivary gland. - Damages the facial nerve (facial nerve runs through parotid gland)
Tracheoesophageal fistula (TEF)?
- Congenital defect resulting in oesophageal atresia and connection between the oesophagus and the trachea. - distal tracheoesophageal fistula is the most common: Distal part of the oesophagus connects with the trachea - symptoms: Vomiting, polyhydramnios (normally amniotic fluid produced by the foetus is mostly swallowed and digested in GIT. in TEF foetus is unable to swallow amniotic fluid leading to polyhydramnios), abdominal distension (air enter the GIT) and aspiration (food from stomach enters the trachea)
What is oesophageal web?
- It is protrusion of the mucosa and submucosa of the oesophagus into the lumen–> narrowing of the lumen of the oesophagus. - can be congenital and acquired. Congenital occurs in middle and inferior thirds of oesophagus. Acquired is most common and occurs in cervical portion. - lead to dysphagia of poorly chewed food - increases risk for oesophageal squamous cell carcinoma -
Characteristics of Plummer-Vinsons Syndrome?
- characterised by iron deficiency anaemia, oesophageal web, beefy red tongue due atrophic glossitis (inflammation of the tongue with loss of lingual papilla –>smooth and erythematous tongue surface.
Zenker Diverticulum?
- out-pouching of the pharyngeal mucosa through muscular wall. - There is acquired defect in the muscular wall - Arises above upper oesophageal sphincter and between the junction of pharynx and oesophagus - symptoms: dysphagia, obstruction and halitosis (bad breath)
Mallory-Weis Syndrome?
- Longitudinal laceration at the Gastroesophageal (GE) junction. - caused by severe vomiting usually due to alcoholism or bulimia - Major symptom: painful hematemesis - Can lead to Boerhaave Syndrome
what is oesophageal varices?
- Dilatation of submucosal veins in the lower oesophagus. - Arises secondary to portal hypertension: 1) Normally upper 1/3 of oesophagus drain into inferior thyroid vein, middle 1/3 drain into azygos vein and lower 1/3 drain into left left gastric vein which drains into portal vein 2) In portal hypertension the blood in left gastric vein backs up into oesophageal veins–> in dilatation (varices) - It is asymptomatic, but the veins can rupture –> painless bleeding (painless hematemesis) - Very common cause of death in liver cirrhosis.
What is achalasia and its pathogenesis?
- Achalasia is oesophageal motility disorder with inability to relax LES - Caused by the damage to ganglion cells of the myenteric plexus (located between the inner circular layer and outer longitudinal layer of muscularis propria) which regulates bowel motility and relaxation of LES. - Damage to ganglion cells can be idiopathic or due to a secondary known insult.
What are the clinical features of achalasia?
- Dysphagia for solids and liquids: oesophageal motility disorder - putrid breath: food accumulates in oesophagus and rottens giving bad smell -Bird-beak sign on barium swallow: dilatation of oesophagus due to accumulated food - Increased risk for oesophageal squamous cell carcinoma.
Gastroesophageal reflux disease (GERD) ?
- Gastric contents is pushed to the oesophagus because of reduced LES tone - Risk factors: Alcohol, tobacco, obesity, fat-rich diet, caffeine, and hiatal hernia (Sliding hiatal hernia: stomach backs up into the oesophagus leading to the hour-glass appearance, and is the most common hernia. Paraesophageal Hernia: Stomach herniates next to the oesophagus, and bowel sounds in lower lung fields can be hear.

What are the clinical features of GERD?
- Heartburn (mimics cardiac chest pain
- Adult ashtma and cough→Damage to enamel and teeth due to acid
- Ulceration with stricture and barrets oesophagus (Metaplasia of lowever oesophageal nonkeratinised stratiefied squamous epithelium to non-cilliated columnar epithelium with goblet cells. It is a response of stem cell to acidic stress and can progress to dysplasia and eventually adenocarcinoma. 10% of cases with GERD develops Barrets oesophagus.)

Esophageal Carcinoma?
– subclassified into adenocarcinoma and squamous cell carcinoma.
– Adenocarcinoma is malignant proliferation of glands in lower esophagus following barrets esophagus. Because glands normally doesn’t exist in lower esophagus therefore barrets esophagus occurs first and it develops into adenocarcinoma. Adenocarcinoma is most common type of esophageal carcinoma in the west
– Squamous cell carcinoma is malignant proliferation of squamous cell. Most common esophageal carcinoma world wide. Usually arise in the upper and middle third of the esophagus.
Risk factors and symptoms for esophageal carcinoma?
Risk factors:
– Alcohol and Tobacco most common cause
– Very hot tea
– Achlasia: rooting food irritates the mucosa and increases the risk for squamous cell carcinoma
– Esophageal web (e.g.plummer Vinson syndrome)
– Esophageal Injury (e.g. lye ingestion)
Symptoms:
– Esophageal carcinoma presents late and has poor prognosis
– progressive dysphagia (from solid to liquid), weight loss, pain and hematemesis
– Hoarse voice (laryngeal recurrent nerve) and cough (trachea)
















